Thank you for showing interest. I do require my reservation form be filled out in its entirety. If however you choose not to fill out the form, you may email me the information. The following information is only required for first time modeling assignments. Returning clients may contact me via email. Thank you in advance. If you do not hear back from me within 24-48 hours of submitting a form, please EMAIL:info@LuXurieLaRen.com

FULL LEGAL NAME *

FULL LEGAL NAME

Please do no use a nickname (e.g. "Tom" for Thomas)

First Name

Last Name

PHONE NUMBER *

PHONE NUMBER

Country

(###)

###

####

EMAIL ADDRESS *

RESIDENT CITY & STATE *

AGE *

ETHNICITY *

PREFERRED METHOD OF COMMUNICATION: *

Email

Phone

Text

HOW DID YOU HEAR ABOUT ME? *

Appointment Details

PREFERRED DATE *

PREFERRED DATE

Please understand that I have a career aside from this industry, which does mean that my availability has limits.

MM

DD

YYYY

PREFERRED TIME *

PREFERRED TIME

Put 00 in for seconds

Hour

Minute

Second

DURATION *

STATE & CITY YOU ARE SEEING ME IN *

PREFERRED LOCATION: *Please be aware that Incalls may require a deposit in advance *

Model Hosted Event

Client Hosted Event

FLY ME TO YOU

CLIENT HOSTED LOCATION (if applicable): *Please give full Address

SPECIAL REQUEST

DRINK PREFERENCE *

MODEL/COMPANION REFERENCES

Please provide the name, email, website address and contact number of at least two reputable models you have spent time with.

REPUTABLE REFERENCE #1: *

REPUTABLE REFERENCE #2: *

Online Screening Services

If you are a member of one or more of the following screening services, please provide the necessary details I need to verify you.

Please provide any Online Screening Services ID's to help verify you *

Acknowledgement

BY CHECKING THIS BOX YOU AGREE YOU HAVE REVIEWED THE RATES. *

Yes

PLEASE VERIFY THAT YOU UNDERSTAND THE FACT THAT I DO NOT SEE ANYONE WHO IS UNABLE TO PROVIDE REFERENCES *

Yes

BY CHECKING THIS BOX, YOU AGREE THAT YOU HAVE REVIEWED AND UNDERSTAND MY CANCELLATION POLICY.

Yes

BY CHECKING THIS BOX YOU UNDERSTAND THAT A 25% DEPOSIT IS REQUIRED TO SECURE YOUR BOOKING *

* This is a non-refundable deposit. Your deposit will be only be refunded if I cancel for any reason.

I understand that this is a non-refundable deposit. My deposit will be fully refunded only if you cancel for any reason.

EMPLOYMENT VERIFICATION

I do offer an extremely discreet employment verification along with a Non Disclosure Agreement (NDA) as a courtesy.

PLEASE BE PREPARED TO EMAIL SEPARATELY (1) ONE THE FOLLOWING: Email to Info@luxurielaren.com Subject Line: EVerification

1. A Business Card
2. Link to a Company Website
3. Company ID Badge

Thank you for making a reservation. If you have not heard from me within 48 hours, please email: info@luxurielaren.com